Missed Opportunities to Increase Adolescent Well-Care Visits


Access to quality primary care services is essential to the health and well-being of children and adolescents. Annual well child visits are important for assessing growth and development and giving anticipatory guidance on nutrition and physical activity to maintain or improve functioning and help combat obesity and childhood diabetes. Timely, consistent care from a Primary Care Physician (PCP) can provide screening for early detection of health issues, appropriate treatment, and preventative services, such as immunizations.

Providers may use episodic and acute care visits to complete necessary well-child screenings, immunizations, and to educate the member and care givers. They may also complete well-child visits, along with sports physicals.

Common issues noted in medical records reviews that prevent the record from closing the gap for the annual well child visits (WCC) and Texas Health Steps (THSteps) include:

  • Missing Body Mass Index (BMI) PERCENTILE (BMI alone does not count)
    • Record Height (HT), Weight (WT) and BMI needed to determine BMI percentile.
    • HT and/or WT are often neglected due to patient being wheelchair bound.
  • Missing documentation for Counseling for Nutrition with patients on enteral nutrition (tube feeding)
    • Record the discussion of the type and amount of enteral feeding to determine if it is sufficient for the healthy growth and development of the patient.
  • Missing documentation for Counseling for Physical Activity with patients in wheelchairs and/or who lack mobility
    •  A discussion and handouts given on exercises that can be done from a wheelchair or lying-in bed for strengthening upper body, legs, and core muscle groups.
  • Missing documentation for Counseling for Physical Activity with parents of toddlers not yet in school or able to ride a bike, etc
    • Plays outside on swing set, jumps on trampoline, etc.
    • Physically active for more than an hour a day. 


For more information, see our Quality Improvement (QI) Toolkit and Tip Sheets. Reference and review the BCBSTX Preventive Care Guidelines (PCGs)Clinical Practice Guidelines (CPGs), and Texas Health Steps (THSteps) for Medical Providers, which includes all current vaccine schedules, ImmTrac2 and other important guidance for treating your patients.

The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.

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